Diabetes is one of the most common lifestyle related disease. The pathologies of diabetes are classified as either type-1 diabetes or type-2 diabetes. Pathophysiologic conditions of type 2 diabetes are mainly classified into several subtypes from “hepatic glucose production”, “insulin secretion capability”, and “insulin resistance”. The majority of diabetics are type 2 characterized by reduced insulin sensitivity, that is, an increase in insulin resistance and impaired insulin secretion from pancreatic β cells. In many cases, type 2 diabetes progresses without any subjective symptom, and a serious complication will develop if diabetes is left as it is.
Terribly, diabetes develops complications of peculiar angiopathy and neuropathy. Such complications occur when blood glucose control has not been satisfactory during progress of the disease for a long period, such as 5 years, 10 years or 20 years. For example, diabetic retinopathy and cataract, which are typical complications, cause vision disorder, and nephropathy causes proteinuria, swelling, and in course of time, leads to uremia. Neuropathy such as feeling of numbness in hands and legs and nerve pain may develop all over the body. Diabetes also accelerates arteriosclerosis, causing angina pectoris, myocardial infarction, cerebral apoplexy and cerebral thrombosis direct to the cause of death. Therefore, primary objects of treatment of diabetes are to prevent the complications and to inhibit the progress. In order to prevent complications, control of blood glucose is a very important factor.
For the treatment of type 2 diabetes, dietary therapy and exercise therapy are performed, which are intended to normalize blood glucose. However, when the above two treatments are not sufficient to normalize blood glucose, oral medicament or insulin injection is employed as medical treatment, so that blood glucose is desirably controlled.
Medicaments used for the treatment of diabetes are as follows:
(1) “sulfonylurea (SU) type drug” acting on pancreatic .beta. cells for promoting secretion of insulin;
(2) “biguanide (BG) type drug” acting mainly on the liver for elevating glucose disposal capacity in the liver and inhibiting release of glucose from the liver;
(3) “.alpha.-glucosidase inhibitors (AGI)” for depressing hyperglycemia after meals by inhibiting .alpha.-glucosidase (disaccharide hydrolysate enzyme) in the intestinal tract and holding up absorption of glucose through the intestinal tract;
(4) “insulin sensitizer (Thiazolidinedione, TZD)” for assisting a decrease of blood glucose by promoting the effects of insulin in the cells and reducing insulin resistance; and
(5) Insulin.
The most suitable treatment program combining the dietary therapy, exercise therapy, and medication is prepared for controlling blood glucose depending on the state of the individual diabetic patients.
The determination of treatment programs is largely dependent on the knowledge and empirical rule of specialists. When analyzing the knowledge and experience of physicians who specialize in diabetes, it was found that treatment policy and programs are determined based on detailed management of the diseases of individual diabetic patients by physicians specializing in diabetes and their clinical findings, laboratory test results and the like.
For example, based on such clinical findings and laboratory results, when the pathophysiologic condition of a diabetic patient is classified from four factors of “excessive hepatic glucose production”, “insulin secretion capability”, “insulin resistance”, and “glucose toxicity” which qualifies these factors, the pathophysiologic condition of diabetes is classified as follows.
A. Type 1 Diabetes
B. Type 2 Diabetes (Peripheral Insulin Resistance); Utilization of glucose in muscles or peripheries is lowered. Most of the patients are obese.
C. Type 2 Diabetes (Excessive Hepatic Glucose Production); The promotion effect of hepatic glycogen synthesis and inhibitory action of gluconeogenesis are lowered. Even though patients are not obese, visceral fat is accumulated in many cases.
D. Type 2 Diabetes (Impaired Insulin Secretion); Secretion of insulin is incomplete because of exhausted pancreatic .beta. cells. Patients are not obese, but are rather emaciated.
It is difficult to have adequate control of blood glucose levels in the standard treatment programs for these conditions, and an optimum treatment program must combine diet, exercise, and medications which correspond to the individual condition. General practitioners and general internists who are not specialists in diabetes may not necessarily be able to realize an optimum treatment program for an individual patient, nor achieve a desired blood glucose level. However, even a general practitioner or general internist may provide treatment suited for an individual diabetic patient if the non-specialist general practitioner or general internist is provided with diagnostic support information to accurately and quantitatively manage the diabetic condition.
Although a number of diagnostic support systems for diabetes exist, most such systems simply monitor the measurements of the patient's blood glucose level, and simply determine an insulin dose from the measurements such as the patient's blood glucose level, and do not provide adequate support information for the non-specialist (for example, refer to Japanese Laid-Open Patent Publication Nos. 10-332704 and No. 11-296598). Furthermore, Diagnostic Criteria for diabetes of the Japan Diabetes Society are well known. Patients are classified as either normal type, borderline diabetic type, or diabetic type based on the presence/absence of a typical diabetic condition and the results of an oral glucose tolerance test, and patients who are classified as diabetic type based on two tests are diagnosed as diabetic.
Existing computer systems which perform diabetes diagnostic support often provide automated determinations based on this diagnostic standard. For example, such systems will input the results of the oral glucose tolerance test and the like, and automatically compare the input data with predetermined standard values, classify the patient as either normal type, borderline diabetic type, or diabetic type, and output the result.
High precision systems also exist which determine whether or not a patient is obese by inputting the patient's combined height and weight, and adding functions to automatically select the medication to be administered.
Since these conventional systems cannot perform detailed analysis of the condition of an individual patient, however, physicians using these conventional systems are not able to provide detailed management of the patient's condition. Accordingly, the patient's condition cannot be properly managed without the subjectivity and broad experience of a specialist, and physicians who are not diabetes specialists and physicians of lesser experience in diagnosing diabetes are unable to make accurate determinations. Even the determinations of specialists are dependent on subjective factors and varying degrees of experience, such that some divergence is inevitable.